Pension trustee application form (UAE)

UAE Single Premium Policy

Pension trustee application form (UAE)

2 Friends Provident International Pension trustee application form

For use with the following UAE products:

QROPS SIPP

Reserve Please tick appropriate product and pension choice. Complete sections relating to your product choice.

Summit

Financial adviser and policy details

Company name

Friends Provident International agency number

Contact details for acknowledgement/queries on the application.

Contact name

Phone number

Email address

Policy number (if known) Please contact us to obtain a pre-allocated policy number if desired.

Please tick to confirm you have included with this application

Personal charging structure (Reserve only)

Verification of scheme member identity*

Verification of scheme member address such as utility bill (or suitable alternative)*

*suitably certified as a true copy of the original

Details of information required for source of wealth can be found on page 10.

This form should be read in conjunction with the current edition of the following documents:

• the relevant brochure

• the relevant product guide(s) where appropriate.

• the relevant Fund Pricing leaflet (Summit only).

Specimen policy conditions are available from us on request.

To clear form click here

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Your investment structure (for Reserve only)

Collective

Personalised QROPS trustees and members should take advice if the member returns to the UK.

Your investor status

Friends Provident International Limited (FPIL) is required to obtain a declaration from you to confirm your investor status, which defines the assets in which you may invest.Your Investor status is used by us to understand the types of asset you wish to invest in. You should let us know whether you wish to hold retail or Non-Retail assets. If you do not tell us we will assume you are a retail investor and wish to hold retail assets only.To assist with customer classification, Friends Provident International’s definitions of a Retail & Non-Retail investor can be found below:

Retail Investor

A Retail investor is any investor other than a Non-Retail (Qualified/Professional) Investor (see below).

Non-Retail Investor (Qualified/Professional)

1 A government, governmental institution or authority, or companies fully owned by any of the aforementioned.2 International bodies and organizations.3 A person or entity licensed to engage in a commercial business, provided that one of the purposes of its business is managing

investments, including: a) A person, body corporate, partnership, trust or other unincorporated association whose ordinary business or professional activity

includes acquiring, underwriting, managing, holding or disposing of investments, whether as principal or agent or giving advice about investments;

b) Any director or partner of, or consultant to, a person referred to in paragraph (a); c) A functionary to a professional investment vehicle or an associate of a functionary to a professional investment vehicle; d) An employee, director or shareholder of, or consultant to, a person in (c) who is acquiring the investment as part of his

remuneration or an incentive arrangement or by way of co-investment; e) A trustee of a family trust settled by, or for the benefit of, one or more persons referred to in paragraphs (c) or (d); f) A trustee or operator of any employment benefit or executive incentive scheme or trust established for the benefit of persons

referred to in paragraphs (c) or (d) or their dependents; g) A government, local authority, public authority or supra-national body.4 A natural person who declares that their annual income is not less than £250,000, or their net equity with the exception of their main

home, exceeds £1,000,000.

It is your responsibility to obtain and read the prospectus and/or offering documents of any assets that you wish to hold in Reserve. This will help you decide whether the asset is suitable for you.

By ticking one of the boxes below you are declaring that you meet the definition as detailed above.

Retail Non-Retail

If you have ticked the box above to indicate you are a Non-Retail Investor, and you have chosen to invest in non-retail (qualified/professional) assets, there may be a requirement for you to complete and sign an additional – asset specific – declaration(s). If this is required, the relevant declaration(s) will be provided by our Technical Investments Team at the time the trade is placed.

As the proposed underlying scheme member, I confirm that I have read and understood the above information with regard to my investor status.

Please complete all details

Please provide all relevant information and documentation so that we can process your application as soon as possible. If you do not provide all relevant information, it may cause a delay in the processing of your application. Further information may be required during the validation process (i.e. questions arising from the information provided).

Please complete this form in English, using block capitals. If you make a mistake, please cross it out and correct it, initialling any amendments. Please do not use correction fluid or any other method for deleting incorrect information.

An Arabic version of this document is available. In a UAE court of law, the Arabic version shall prevail.

Name Signed

Date (dd/mm/yyyy)


Discretionary Fund Manager (for Reserve only)

Do you wish to appoint a Discretionary fund manager?

Yes – full Yes – partial If Yes, please complete the appointment of discretionary fund manager and custodian section on page 29.

No

Additional information/Special instructions

Please let us know in the space below of any additional information we need to be aware of relating to the application.

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Section 1: Setting up your policy Corporate trustees

Company name

Registered address

Country of registration

Registration number

Regulated by

Authorisation number

Telephone number

Fax number

Email address (mandatory)

Correspondence address (if different from above)

Correspondence address phone number

Contact name

Telephone number

Fax number

You will receive your policy documents and all correspondence relating to your policy, unless you indicate otherwise below. Copies will also be sent to your financial adviser. (Please refer to page 8 to provide instructions regarding valuation statements dispatch.)

Alternatively, please tick here if you would prefer us to send your policy documents and all correspondence relating to your policy to your financial adviser only.

Member as trustee details

If the member is to be a trustee, please complete the following information.

Member as trustee

Title Mr Mrs Miss Ms Other

Surname (as shown on passport/ID card)

First name(s) (as shown on passport/ID card)

ID card/ Passport number

Date of birth (DD/MM/YYYY)

Country of residence

Nationality

Please write in ink and use block capitals.


Section 1: Setting up your policy (continued)

Member as trustee details (continued)

Residential address

Email address

Position or occupation (if retired, please state former occupation)

Please tick here if the member is to be a life assured

Lives assured details

This section should be completed by any lives assured whose details have not already been provided. (If more than two lives assured are required, please complete the supplementary form for Additional lives assured) Name(s) to be stated as they appear on either your ID card or passport, as applicable.

Life assured Life assured

Title Mr Mrs Miss Ms Mr Mrs Miss Ms

Other Other

Surname (as shown on passport/ID card)

Forename(s) (as shown on passport/ID card)

Date of birth (DD/MM/YYYY)

Country of residence

Nationality

Residential address

Relationship to scheme

Politically Exposed Persons

If you, the trustee, or any party connected to this application, could be defined as a politically exposed person (PEP) (for examples and guidance, refer to important notes), please provide details.

1 Title Mr Mrs Miss Ms Other

2 Surname (as shown on ID card/passport)

3 First name(s) (as shown on ID card/passport)

4 Connection to policy

5 Position held as a PEP

6 In what country is/was the position held?

7


Entity tax compliance questionnaire

Please answer all questions.

1 Is the applicant a US specified person? Yes No If Yes, please state the tax identification number below.

2 Is the applicant UK resident? Yes No If Yes, please state the tax identification number below.

If you have answered No to either of Questions 1 and 2, please state the countries where the trust is resident for tax purposes.

Country 1

Tax identification number

Country 2


Country 3


3 Is the applicant a Financial Institution issued with a Global Intermediary Identification Number (GIIN)?

Yes No If Yes, please indicate GIIN number

If a GIIN is yet to be issued, please notify us when received.

4 Is the applicant a Financial Institution without a GIIN? Yes No If Yes, please state the reason. If you have answered Yes, you

may wish to contact us prior to submitting this application.

5 Is the applicant a trustee of a UK pension scheme registered under Part 4 of the Finance Act 2004?

Yes No

6 Is the applicant exempt from FATCA/IGA tax reporting? Yes No If Yes, please state the reasons.

7 Is the applicant a trustee documented trust? Yes No If Yes, please

indicate the sponsoring entity’s GIIN number.

Please contact us if you believe that none of the above are applicable to the entity.

Total premium

I wish to pay Sterling (GBP) US dollars (USD) Euro (EUR)

Other Amount

Please refer to the relevant principal brochure for the minimum premium. Reserve only: In the event of Asset Exchanges, please complete the asset exchange form, which is available from your financial adviser.



Number of policy segments

For Reserve, please indicate number of policy segments required (Maximum 100, minimum 1)

If this box is left blank, then 100 policies will be issued.

For Summit, please indicate number of policy segments required (Maximum 25, minimum 5)

If this box is left blank, then 5 policies will be issued.

Plan currency

Please select the currency in which you wish your policy to be denominated (this will be the policy currency in which your policy is valued, and total premium figure calculated). Please refer to the relevant brochure for currency options.

Dirhams (AED)

Sterling (GBP)

US dollar (USD)

Euro (EUR)

Swiss franc (CHF)

Australian dollar (AUD)

Swedish krona (SEK)

Japanese yen (JPY)

Note: For Summit only USD, GBP, EUR and AED currencies can be used. For Reserve, AED currency cannot be used.

Valuations (for Reserve only)

We confirm that we require quarterly valuations to be sent to us by electronic mail to the email address provided on page 4. A copy will be sent to our introducing financial adviser. We understand if this option is selected paper copies will not be provided to us, we will receive a valuation in digital format. If this option is selected, we will also be sent the trade contract notes by electronic mail. All emails will be encrypted using WINZIP software and a PDF reader will be required. A password will be sent to us directly to access this file.

We confirm that we require quarterly valuations to be sent to us by post. A copy will be sent to our introducing financial adviser. We understand if this option is selected email copies will not be provided to us. If this option is selected we will also be sent the trade contract notes in paper format.If both of the above boxes are left blank, valuations will be sent direct to the introducing financial adviser.

9

Section 2: Policy detailsInvestment instructions (for Reserve only)

If you would like us to place the investments within your Reserve policy, and for our appointed custodian to hold custody of them, please state your chosen investments below. If you are using the services of a discretionary fund manager, please leave blank. If there is insufficient room, please use a separate sheet, signed by all applicants. Charges will be deducted from the General Transaction Account. Therefore, if an overdrawn balance is to be avoided, please ensure sufficient cash is retained in line with your investment strategy.

Currency

Units Shares/Bonds/

Cash amountSEDOL/ISIN(essential)† Full security/fund name description

† If no SEDOL or ISIN is provided, Friends Provident International accepts no liability for the funds selected.

Your investment options (for Reserve only)

Investment adviser (go to page 25) Please complete this section if you would like an investment adviser to take authority over investment decisions.

Discretionary fund manager and custodian (go to page 29)

Please complete this section if you would like to appoint a discretionary fund manager for your investments.


Section 2: Policy details (continued)

Choice of funds (Summit only)

Please indicate the funds in which you wish your policy to invest, up to a maximum of 10, showing the percentage of each investable premium you wish to be invested in each fund. The total percentage must add up to 100% (please note we can only accept whole percentages). Failure to include all relevant information accurately may delay the processing of your application.

Fund code Fund

Percentage of premium (must

total 100%)

%

%

%

%

%

%

%

%

%

%

Total 100%

Source of wealth

Please provide details below of the source(s) of the premium for your policy.

Transfer of pension Pension name

Pension account number

Pension currency and value Currency Amount

Transfer date

Pension name



Transfer date

Pension name



Transfer date

11


Source of wealth (continued)

Pension name



Transfer date

Pension name



Transfer date

Please complete the rest of this section if the member is either a resident of the United Arab Emirates (UAE) or, if the member is not a UAE resident but is signing this application form in the UAE. This information is mandatory and the application cannot be processed without it.

1 Please state the member’s net annual income for the last 3 years Year 1 USD GBP EUR AED

Amount

Year 2 USD GBP EUR AED

Amount

Year 3 USD GBP EUR AED

Amount

2 Please give details of assets held by the member

Total cash in bank USD GBP EUR AED

Amount

Total value of shares and equities USD GBP EUR AED

Amount

Total property value USD GBP EUR AED

Amount

Total of all other investments USD GBP EUR AED

Amount



Source of wealth (continued)

3 Please give details of liabilities held by the member

Total outstanding loans to be paid (issues by banks)

USD GBP EUR AED

Amount

Total of outstanding balance to be paid on other loans

USD GBP EUR AED

Amount

Total of outstanding balance to be paid on credit cards

USD GBP EUR AED

Amount

4 Please give details of banks where the member holds accounts

Please detail below the names of the bank(s) and branch address(es), where the member holds accounts. Please continue on a separate sheet if necessary.

Bank name(s) a)

b)

Bank branch address(es) a)

b)

5 Please give details of other insurance policies held by the member

Please continue on a separate sheet if necessary.

Policy number

Provider

Premium currency USD GBP EUR AED

Premium amount per year

Status (paying, surrendered, paid up)

Policy number

Provider

Premium currency USD GBP EUR AED

Premium amount per year

Status (paying, surrendered, paid up)

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Declarations

The following declarations are for Reserve only. For Summit, please go to page 17.

Friends Provident International will require you to declare that you meet the criteria for a professional (Non-Retail) investor if you or your adviser wish to trade professional (Non-Retail) assets in your Reserve.

Important notes – Reserve

1 A specimen policy document and/or a copy of this completed form are available on request. These are important and valuable documents and it is likely that you will need to refer to them in the future. You are advised to keep them together with the Policy Document and any further correspondence relating to your policy in a safe place.

2 You are advised to satisfy yourself/selves that, under any taxation, exchange control or insurance legislation to which you may be subject, you are permitted to effect the policy.

3 You should seek guidance from your financial adviser as to the suitability of the policy to your own particular circumstances. Reserve should be regarded as a medium to long-term investment (five years or more).

4 Each policy is governed by and shall be construed in accordance with the laws of the United Arab Emirates.5 A politically exposed person is a person who is or has been entrusted with prominent public functions .This includes: head of state,

head of government, minister or deputy or assistant minister, senior government official, member of parliament, senior politician, important political party official, senior judicial official, member of a court of auditors or the board of a central bank, ambassador, chargé d’affaires or other high-ranking officer in a diplomatic service, high-ranking officer in an armed force, senior member of an administrative, management or supervisory body of a state-owned enterprise, senior member of management of, or a member of, the governing body of an international entity or organization or honorary consul. A politically exposed person is also a family member or a close associate of such a person. This applies to the applicant, policyholder, life assured, payer of the payment, beneficiary or any other party connected to this application.

Please refer to the Isle of Man Anti-Money-Laundering and Countering the Financing of Terrorism Code 2015 for the full definition of a “politically exposed person”, and in particular, further elaboration on whether a person is a “family member” or a “close associate”.

6 Investment acknowledgement Reserve gives you an investment choice from a very wide-ranging menu of investments. Some of the funds which are available to

you are classed as Non-Retail funds aimed at Non-Retail (qualified/professional) investor. If you were investing in such a fund directly yourself, rather than through your Reserve policy, you may have to declare that:

• You have read and understood the information supplied to you and understand the nature of any risks involved.

• You have discussed with your financial adviser whether such an asset is appropriate to your investment portfolio.

• You are eligible and able to invest into the fund and have the level of investment knowledge and experience required by the fund manager.

• You meet certain minimum financial requirements. Please note that different jurisdictions may impose different criteria on the generally accepted definition of a Non-Retail

(qualified/professional) investor. Full definitions, restrictions and investor requirements can be found in each fund’s prospectus/terms and conditions, which are available from the fund manager or your financial adviser. We require that you obtain, read and fully understand a copy of the prospectus/terms and conditions for your chosen investment.

7 Liquidity information Some funds may have restrictions on their ability to pay redemptions due to the type of underlying investments they hold. This could

limit your ability to raise cash from the fund in the future. Investment into specialist funds should be considered a long-term investment. You, in conjunction with your financial adviser, should

consider the amount you invest via your policy if it is likely that you will need access to your capital quickly in the future.

Declarations – Reserve

Attention is drawn to the following declarations. Where we have asked for information that we need to assess before we can accept your application, you must disclose all facts which are material. Such facts are those which an insurer would regard as likely to influence the assessment and acceptance of a proposal. If you are in doubt as to the relevance of any particular information you should disclose it, as failure to do so could result in the policy being invalid.1 Investment declarations Before you invest in any assets through your Reserve policy, we want to ensure that you are aware of the nature and possible risks

associated with them. Would you therefore please make the following declarations:a) We understand that we may choose the investments to which our Reserve policies are to be linked.b) We acknowledge that it is our responsibility to ensure that the asset is suitable, considering our underlying investment objectives

and attitude to risk.c) We confirm that we understand certain assets may have restrictions on their ability to raise cash in the future, and that further

details are included in the prospectus or terms and conditions for the respective underlying investment. We understand the risks associated with investing in these assets.

d) If we choose to invest into assets aimed at professional investors, We acknowledge that it is our responsibility to obtain, read and understand the fund prospectus or equivalent offering documents as appropriate.

e) We acknowledge that Friends Provident International is not responsible for the investment performance or any loss suffered or reduction in the value of our Reserve policy, arising from my/our chosen investment. Friends Provident International does not have any responsibility for the investment management of the assets within our policy and Friends Provident International does not approve any asset as a suitable investment.


Declarations (continued)

Declarations – Reserve (continued)

1 Investment declarations (continued)f) We acknowledge that Friends Provident International reserves the right to reject any asset, for example, if certain administration

criteria are not met.g) We acknowledge the purchase of our investments may be delayed if Friends Provident International requires a signed declaration

in respect of our chosen investments. In the event that a declaration is required, this must be signed by the underlying client(s) and reflect their knowledge and circumstances, rather than that of the appointed Pension Trustees.

h) We acknowledge that the purchase of our investments are processed according to the terms and conditions of the relevant institution that cash is being invested with.

i) We acknowledge that specific investor protection and compensation schemes that may exist in relation to collective investments and deposit accounts are unlikely to apply in the event of failure of such an investment held within insurance policies.

j) We have declared our investor status on the application form and understand that if we do not declare this, Friends Provident International will assume I am a retail investor.

k) We acknowledge that some of the investments made available by Friends Provident International may be Experienced, Professional, Qualified or Sophisticated Investor Funds as defined under the applicable legislation. We realise that these types of investment are not intended for general sale to retail investors.

l) We are aware that Friends Provident International will be regarded by the asset manager as the investor for the purposes of investment.

m) We accept that some investments involve a high level of risk and that it is our responsibility to read the investment documentation, including any risk warnings, provided by the investment manager.

n) We have discussed with our independent financial adviser whether such an asset is appropriate to our investment portfolio. o) We accept that Friends Provident International requires us to confirm that we have read and understood the investment

documentation and risk warnings for any asset we wish to invest in. p) For investment into Non-Retail assets, we acknowledge that Friends Provident International will require us to sign an additional

declaration confirming that we qualify and meet the required standards to be able to invest. q) We are aware that the declaration must be signed before Friends Provident International can place the investment and, in all cases,

Friends Provident International has the right to decline the investment without providing a reason.

2 General declarations

We, the current trustees of the trust created on the day of (month) (year)

(name of the trust)

confirm the following to Friends Provident International:a) That we have the necessary powers of investment to invest in policies of life assurance.b) That the trustees detailed in Section 1 of this application form are the current trustees of the trust.c) The principal beneficiary/member is;

Full name Address

Nationality Date of birth

d) That without prejudice to the generality of this clause, the trust company’s required number of authorised signatories must sign all types of instructions (for example, instructions to change underlying investments, make cash withdrawals, totally surrendering the policy.

e) That we will advise Friends Provident International in writing immediately of any changes in the trustees.

We further declare that all the information provided in this application, including this Declaration, is complete and true to the best of our knowledge and belief. We agree that they shall form the basis of the policy under the laws of the United Arab Emirates.

We have received, read and have been given an explanation of all the printed materials relevant to this policy and we have been acquainted with the management charges made by Friends Provident International.

We are aware that tax evasion is a criminal offence and we will not use this policy to evade tax. We understand that Friends Provident International has statutory obligations to report suspicions of criminal wrongdoing including tax evasion to law enforcement agencies or other relevant authorities in the locations where it operates. We are responsible for our own tax affairs and we hereby declare that we understand our personal tax obligations and responsibilities and we have complied with all legal requirements to make declarations to tax authorities and pay the tax that we owe. As appropriate and necessary we have taken, or will take, legal advice in relation to our tax affairs and in particular, our tax obligations as they apply to this application.

15



We understand that the Isle of Man Government has and will be entering into a number of inter-governmental agreements to share tax information, where applicable, with the tax authorities in other territories. We understand that there is a requirement to collect information about customers’ tax residence and nationality as part of Isle of Man legislation and that as a financial services company Friends Provident International is legally obliged to collect it. We are aware that Friends Provident International is required to request the entity’s tax residency and tax identification number/global intermediary identification number (where applicable), and where controlling persons are potentially reportable their tax residency, tax identification number (where applicable) and nationality and will record this information.

We understand that for reportable controlling persons, the information that will be reported to the Isle of Man Government is:

• The controlling person’s name, address, jurisdiction of tax residence, tax identification number and date of birth.

• The Friends Provident International contract number.

• The balance or value of the account at the end of the calendar year or at the date the policy was cashed in.

• The sum of any withdrawals taken within the relevant reporting year.

Financial adviser advice declarationThe advice provided by the financial adviser was received by the principal beneficiary/member in (country)

Signed by financial adviser

3 Premium tax/Withholding tax

We acknowledge that in the event of any premium tax or withholding tax being levied in our country of residence, it will be our responsibility to increase the payment by an appropriate amount or to settle the liability directly with the relevant tax authorities.

4 Cancellation rights

You will be able to cancel your investment up to 30 days from the day you receive the cancellation notice and contract documents. You will receive a refund of the payment less a deduction for shortfall to reflect any fall in the markets in the interim and, where applicable, less any initial fee which was facilitated by us to your financial adviser. The cancellation period begins when you receive the cancellation notice and all contractual documentation and lasts for 30 days. If you wish to cancel you should follow the instructions in the cancellation notice.

A separate cooling off period will apply to a subsequent premium in relation to that new premium only.

5 Data protection

Please read this privacy notice carefully. Please be aware that this is a short version of our privacy policy and you should visit www.fpinternational.com/legal/privacy-and-cookies.jsp to view the full policy.

Friends Provident International Limited (“FPIL”) is the controller of your personal data processed in connection with this application and product. The data which we process is that which you provide in this form such as your names, contact details and information about medical history. As well as obtaining data directly from yourself, we may obtain additional information from your doctor(s) as further described in this application form.

We use your information to process and underwrite your application, administer your policy and handle any claims, to help detect and prevent fraudulent activity, and for customer profiling and marketing. We only retain your data for as long as is necessary for the maintenance of your contract, or for legal or regulatory requirements.

We may share your data with third parties who provide services to us, some of whom may be located outside of the Isle of Man, European Economic Area (EEA), or country in which your data was collected. In these cases we make sure that your data is protected to the same standards as in the Isle of Man, EEA, or country of data collection. We may also share your data with law enforcement and regulatory bodies, other insurers, your insurance intermediary and their service providers.

Data protection laws require us to tell you what legal basis we use for processing your personal data. In general, the processing is necessary to perform a contract with you, or to take steps requested by you before entering into this contract.

We will not normally carry out any direct marketing campaigns but if we do, we will always contact you first and give you the opportunity to opt in to direct marketing before any communications of this nature take place.

We may process data about you which the law considers to be sensitive, in particular health information. In this case, we base our processing on your freely given, informed, specific consent or that the processing is necessary for the establishment, exercise or defence of legal claims. We may also process this type of data about other people you wish to insure such as family members. Please tell these people to read this privacy notice and our privacy policy so that they understand how FPIL may use their personal data.




By proceeding with this application:

• You understand that we will use information about you, including information about health, for the above purposes.

• You are confirming that any other person (eg a family member or other individual covered by your insurance policy, or whose information is relevant to use providing this policy coverage) whose information you are providing understands and has no concerns about their information being used in this way.

NOTE: If you have any concerns about use of information for these purposes, you should not proceed with this application as we may be unable to provide you with a policy. You can also contact us at any time if you would like to ask us to cease using your information, but this may result in your policy being cancelled.

You have various rights in relation to your personal data including accessing your data, and in some limited circumstances objecting to processing or having your data erased.

You can find out more information about how to exercise these rights and details of who to contact with queries on our privacy practices by viewing our full privacy policy available on our website www.fpinternational.com/legal/privacy-and-cookies.jsp or it can be provided upon request from our Data Protection Officer, Friends Provident International Limited, Royal Court, Castletown, Isle of Man, British Isles IM9 1RA.

By signing this form we consent to this use of our personal data.

6 Financial adviser

We acknowledge that Friends Provident International and our financial adviser have entered into an agreement (‘terms of business’) which sets out the basis upon which Friends Provident International is prepared to accept applications submitted by the financial adviser on our behalf. This agreement categorically states that the financial adviser acts as our agent, and not the agent of Friends Provident International. We acknowledge that our financial adviser, or any other, has no authority to act as the agent of Friends Provident International or to state, suggest or imply that it has such authority.

7 Fees and commissions

We are aware that certain investments the financial adviser makes from time to time may contain fees which exist partly to meet promotion and distribution expenses of the investment, including commission paid to our adviser. We understand that full details of any commissions paid in respect of certain investments held within the Reserve policy are available on request from our adviser.

We acknowledge that the above fees and commissions are in addition to Friends Provident International’s Reserve policy charges and any annual fee taken on our Reserve policy by our independent financial adviser.

First authorised signatory of trustee company Second authorised signatory of trustee company

Signature(s)

Name (block capitals)

Date

This application was signed in (country)

Member as co-trustee (if applicable)Signature(s)


Date

17


The following declarations are for Summit only. For Reserve, please go to page 12.

Important notes – Summit

1 A specimen policy document and/or a copy of this completed form are available on request. These are important and valuable documents and it is likely that you will need to refer to them in the future. You are advised to keep them together with the Policy Document and any further correspondence relating to your policy in a safe place.

2 You are advised to satisfy yourself/selves that, under any taxation, exchange control or financial legislation to which you may be subject, you are permitted to effect the policy.

3 You should seek guidance from your financial adviser as to the suitability of the policy to your own particular circumstances. Summit should be regarded as a medium to long-term investment. We are not responsible for providing any advice as to the suitability of any asset for your investment objectives and risk profile.

4 Each policy is governed by and shall be construed in accordance with the laws of the United Arab Emirates.

5 A politically exposed person is a person who is or has been entrusted with prominent public functions .This includes: head of state, head of government, minister or deputy or assistant minister, senior government official, member of parliament, senior politician, important political party official, senior judicial official, member of a court of auditors or the board of a central bank, ambassador, chargé d’affaires or other high-ranking officer in a diplomatic service, high-ranking officer in an armed force, senior member of an administrative, management or supervisory body of a state-owned enterprise, senior member of management of, or a member of, the governing body of an international entity or organization or honorary consul. A politically exposed person is also a family member or a close associate of such a person. This applies to the applicant, policyholder, life assured, payer of the payment, beneficiary or any other party connected to this application.

Please refer to the Isle of Man Anti-Money-Laundering and Countering the Financing of Terrorism Code 2015 for the full definition of a “politically exposed person”, and in particular, further elaboration on whether a person is a “family member” or a “close associate”.

6 Underlying fund prospectuses are available from us on request.

7 Liquidity Information

Some of our funds may have restrictions on their ability to pay redemptions due to the type of underlying investment they hold. This could limit your ability to raise cash from the fund in the future.

Investing in funds should be considered a long-term investment. You in conjunction with your financial adviser, should consider the amount you invest via your policy if it is likely that you will need access to your capital quickly in the future.

Declarations – Summit

Attention is drawn to the following declarations. If the application form requests information which has to be assessed by Friends Provident International before acceptance, you must disclose all facts which are material. Such facts are those which an insurer would regard as likely to influence the assessment and acceptance of a proposal. If you are in doubt as to the relevance of any particular information you should disclose it, as failure to do so could result in you being provided with the wrong terms, a request being rejected or reduced, or the policy being invalid.

1 Fund Acknowledgement

Before you invest in any assets through your policy, we want to ensure that you are aware of the nature and possible risks associated with them. Would you therefore please make the following declarations:

a) We understand that we may choose the investments to which our policies are to be linked.

b) We acknowledge that it is our responsibility to ensure that the asset is suitable, considering our underlying investment objectives and attitude to risk.

c) We confirm that we understand certain assets may have restrictions on their ability to raise cash in the future, and that further details are included in the prospectus or terms and conditions for the respective underlying fund. We understand the risks associated with investing in these funds and understand that we may be investing into funds not aimed at the general public and agree to investments in such funds.

d) When investing into mirror funds we acknowledge that it is our responsibility to obtain, read and understand the underlying fund’s prospectus.

e) We acknowledge that Friends Provident International is not responsible for the investment performance or any loss suffered or reduction in the value of our policy, arising from our chosen investment. Friends Provident International does not have any responsibility for the investment management of the assets within our policy and Friends Provident International does not approve any asset as a suitable investment.

f) We acknowledge that the purchase of our investments may be delayed if Friends Provident International requires a signed declaration in respect of our chosen investments.

g) We acknowledge that specific investor protection and compensation schemes that may exist in relation to collective investments and deposit accounts are unlikely to apply in the event of failure of such an investment held within insurance contracts.

h) We acknowledge that Friends Provident International has not provided any advice as to the suitability of any asset for my investment objectives and attitude to risk.

i) We acknowledge that Friends Provident International may from time to time provide us with investment literature which explains the investment options available to us. We acknowledge that the provision of such investment literature is by way of information only and is not provided by way of investment advice.



Declarations – Summit (continued)

2 General declarations

We, the current trustees of the trust created on the day of (month) (year)

(name of the trust)

confirm the following to Friends Provident International:a) That we have the necessary powers of investment to invest in policies of life assurance.b) That the trustees detailed in Section 1 of this application form are the current trustees of the trust.c) The principal beneficiary/member is:

Full name Address

Nationality Date of birth

d) That without prejudice to the generality of this clause, the trust company’s required number of authorised signatories must sign all types of instructions (for example, instructions to change underlying investments, make cash withdrawals, totally surrender the plan).

e) That we will advise Friends Provident International in writing immediately of any changes in the trustees. We further declare that all the information provided in this application, including this Declaration, is complete and true to the best of

our knowledge and belief. We agree that they shall form the basis of the policy under the laws of the United Arab Emirates. We have received, read and have been given an explanation of all the printed materials relevant to this policy and we have been

acquainted with the management charges made by Friends Provident International. We are aware that tax evasion is a criminal offence and we will not use this policy to evade tax. We understand that Friends Provident

International has statutory obligations to report suspicions of criminal wrongdoing including tax evasion to law enforcement agencies or other relevant authorities in the locations where it operates. We are responsible for our own tax affairs and we hereby declare that we understand our personal tax obligations and responsibilities and we have complied with all legal requirements to make declarations to tax authorities and pay the tax that we owe. As appropriate and necessary we have taken, or will take, legal advice in relation to our tax affairs and in particular, our tax obligations as they apply to this application.

We understand that the Isle of Man Government has and will be entering into a number of inter-governmental agreements to share tax information, where applicable, with the tax authorities in other territories. We understand that there is a requirement to collect information about customers’ tax residence and nationality as part of Isle of Man legislation and that as a financial services company Friends Provident International is legally obliged to collect it. We are aware that Friends Provident International is required to request the entity’s tax residency and tax identification number/global intermediary identification number (where applicable), and where controlling persons are potentially reportable their tax residency, tax identification number (where applicable) and nationality and will record this information.

We understand that for reportable controlling persons, the information that will be reported to the Isle of Man Government is: • The controlling person’s name, address, jurisdiction of tax residence, tax identification number and date of birth. • The Friends Provident International contract number. • The balance or value of the account at the end of the calendar year or at the date the policy was cashed in. • The sum of any withdrawals taken within the relevant reporting year.

Financial adviser advice declarationThe advice provided by the financial adviser was received by the principal beneficiary/member in (country)

Signed by financial adviser

19



3 Premium tax/Withholding tax We acknowledge that in the event of any premium tax or withholding tax being levied in our country of residence, it will be our

responsibility to increase the payment by an appropriate amount or to settle the liability directly with the relevant tax authorities.

4 Cancellation rights You will be able to cancel your investment up to 30 days from the day you receive the cancellation notice and contract documents.

You will receive a refund of the payment less a deduction for shortfall to reflect any fall in the markets in the interim and, where applicable, less any initial fee which was facilitated by us to your financial adviser. The cancellation period begins when you receive the cancellation notice and all contractual documentation and lasts for 30 days. If you wish to cancel you should follow the instructions in the cancellation notice.

A separate cooling off period will apply to a subsequent premium in relation to that new premium only.

5 Data protection Please read this privacy notice carefully. Please be aware that this is a short version of our privacy policy and you should visit

www.fpinternational.com/legal/privacy-and-cookies.jsp to view the full policy.

Friends Provident International Limited (“FPIL”) is the controller of your personal data processed in connection with this application and product. The data which we process is that which you provide in this form such as your names, contact details and information about medical history. As well as obtaining data directly from yourself, we may obtain additional information from your doctor(s) as further described in this application form.

We use your information to process and underwrite your application, administer your policy and handle any claims, to help detect and prevent fraudulent activity, and for customer profiling and marketing. We only retain your data for as long as is necessary for the maintenance of your contract, or for legal or regulatory requirements.

We may share your data with third parties who provide services to us, some of whom may be located outside of the Isle of Man, European Economic Area (EEA), or country in which your data was collected. In these cases we make sure that your data is protected to the same standards as in the Isle of Man, EEA, or country of data collection. We may also share your data with law enforcement and regulatory bodies, other insurers, your insurance intermediary and their service providers.

Data protection laws require us to tell you what legal basis we use for processing your personal data. In general, the processing is necessary to perform a contract with you, or to take steps requested by you before entering into this contract.

We will not normally carry out any direct marketing campaigns but if we do, we will always contact you first and give you the opportunity to opt in to direct marketing before any communications of this nature take place.

We may process data about you which the law considers to be sensitive, in particular health information. In this case, we base our processing on your freely given, informed, specific consent or that the processing is necessary for the establishment, exercise or defence of legal claims. We may also process this type of data about other people you wish to insure such as family members. Please tell these people to read this privacy notice and our privacy policy so that they understand how FPIL may use their personal data.

By proceeding with this application: • You understand that we will use information about you, including information about health, for the above purposes. • You are confirming that any other person (eg a family member or other individual covered by your insurance policy, or whose

information is relevant to use providing this policy coverage) whose information you are providing understands and has no concerns about their information being used in this way.

NOTE: If you have any concerns about use of information for these purposes, you should not proceed with this application as we may be unable to provide you with a policy. You can also contact us at any time if you would like to ask us to cease using your information, but this may result in your policy being cancelled.

You have various rights in relation to your personal data including accessing your data, and in some limited circumstances objecting to processing or having your data erased.

You can find out more information about how to exercise these rights and details of who to contact with queries on our privacy practices by viewing our full privacy policy available on our website www.fpinternational.com/legal/privacy-and-cookies.jsp or it can be provided upon request from our Data Protection Officer, Friends Provident International Limited, Royal Court, Castletown, Isle of Man, British Isles IM9 1RA.By signing this form we consent to this use of our personal data.

6 Financial adviser

We acknowledge that Friends Provident International and our financial adviser have entered into an agreement (‘terms of business’) which sets out the basis upon which Friends Provident International is prepared to accept applications submitted by the financial adviser on our behalf. This agreement categorically states that the financial adviser acts as our agent, and not the agent of Friends Provident International. We acknowledge that our financial adviser, or any other, has no authority to act as the agent of Friends Provident International or to state, suggest or imply that it has such authority.




7 Fees and commissions

We are aware that certain investments the financial adviser makes on my behalf, from time to time, may contain fees which exist partly to meet promotion and distribution expenses of the investment, including commission paid to our adviser. We understand that full details of any commissions paid in respect of certain investments held within the Summit policy are available on request from our adviser.

We acknowledge that the above fees and commissions are in addition to Friends Provident International’s Summit policy charges and any annual fee taken on our Summit policy by the adviser.

First authorised signatory of trustee company Second authorised signatory of trustee companySignature(s)


Date




Date


21

Bank instruction letter (non-Middle East bank accounts)

Applicable to applications for Summit.

Only applicable to applicants who are paying in US dollars, sterling or euro.

Please note that some banks insist that their own Bank instruction form is used, so you should check with your bank that they will accept this document.

This form should be returned with your application form.

Please use block capitals.

Name and full postal address of your bank

To: The Manager (Bank)

Bank address

(postcode, if applicable)

Account number

Account currency (must be completed if the account is multi-currency)

Account holder’s name

Sort code (if applicable) – –

SWIFT/BIC code (if applicable)

IBAN (if applicable)

Section A – Telegraphic transfers

Dear Sir,

On our behalf, please remit to Bank HSBC, 8 Canada Square, London E14 5HQ, Swift/BIC code: MIDLGB22, account name: Friends Provident International Limited.

IBAN: GBP GB86MIDL40193822566621, EUR GB95MIDL40051558980092, USD GB42MIDL40051558980076

The reference number below (see Section B) must be quoted by the Bank on all advices.

GBP USD EUR (figures)

GBP USD EUR (words)

Please charge the amount of the payment together with any bank and agent bank’s charges to my/our account.

Yours faithfully,

Signature(s) of applicant(s)

Date

My address

Section B (to be completed by Friends Provident International)

This reference number must be quoted by the bank on all advices.


Bank instruction letter (Middle East bank accounts only)

Applicable to applications for Summit.

Only applicable to applicants with bank accounts in the Middle East.

Please note that some banks insist that their own Bank instruction form is used, so you should check with your bank that they will accept this document.

This form should be returned with your application form.




Bank address


Account number






Section A – Telegraphic transfers

Dear Sir,

On my behalf would you please prepare a Telegraphic Transfer and carry out the transaction indicated within 48 hours of you receiving this instruction.

Please remit to HSBC Bank Middle East Limited, Level 2, Building 3, Emaar Square, PO Box 506201, Dubai, United Arab Emirates, SWIFT Code BBMEAEAD, for credit to Friends Provident International Limited, beneficiary account number shown below.

Sterling (GBP) transfer – IBAN AE250200000025171067212

US dollars (USD) transfer – IBAN AE520200000025171067211

Dirham (AED) transfer – IBAN AE610200000025171067437

The reference number below (see Section B) must be quoted by the Bank on all advices.

GBP USD AED (figures)

GBP USD AED (words)

Please charge the amount of the payment together with any bank and agent bank’s charges to my/our account.

Yours faithfully,


Date

My address



23


Please note that some banks insist that their own bank instruction form is used, so you should check with your bank that they will accept this document.



Bank address


Account number






Section A

Dear Sir,

On our behalf, please remit to Isle of Man Bank Limited, East Region, Douglas, Sort code: 60-95-45, Swift code: RBOSIMD2,

IBAN: GB86RBOS60954540038965, account name: Friends Provident International Limited, account number: 9545-40038965,

carrying out the transaction indicated within 48 hours.

If remitting Sterling from a UK/Channel Island or Isle of Man bank, please send the payment by: BACS CHAPS Faster Payment

Payments in other currencies must be made by telegraphic transfer.

The reference number below (see Section B) must be quoted by the bank on all advices.

GBP USD EUR Other (figures)

GBP USD EUR Other (words)

Please charge the amount of the payment together with any bank and agent bank’s charges to our account.

Yours faithfully,


Date

Our address



Bank instruction letter

Applicable to applications for Reserve.


Investment adviser

Only applicable to applications for Reserve.

Section 3: Investment restrictionsInvestment restrictions – Reserve

The following lists show the assets permitted within the collective investments and personalised assets versions of this policy. It is important that you understand which version you will be investing in and do not invest outside of these parameters.

Each asset will be vetted on an individual basis against our internal criteria and we reserve the right to refuse any asset.

Friends Provident International is the beneficial owner of all of the assets held within the policy, which are held in Friends Provident International’s name.

a) Collective investments

This option allows you to invest in the following:

• UK authorised unit trusts

• UK authorised investments trusts or an overseas equivalent (excluding warrants)

• UK REIT or an overseas equivalent

• open-ended investment companies

• an interest in an overseas collective investment scheme†, that is structured as one of the following:– an open-ended investment company– a unit trust– offshore reporting and non-reporting funds.

• hedge funds and exchange-traded funds are permitted provided they comply with one of the structures above

• Authorised Contractual Schemes* *Authorised Contractual Schemes – as defined by section 235A(1) of UK Financial Services and Markets Act 2000.

• cash, including bank and building society deposits.† ‘Collective Investment’ as defined in Section 235 of the UK Financial Services and Markets Act 2000.

b) Personalised assets

The personalised assets option allows you to invest in the following:

• equities and fixed-interest securities quoted (including Sukuks) on most recognised stock exchanges

• unit trusts

• open-ended investment companies

• investment trusts

• Real Estate Investment Trusts

• offshore reporting and non-reporting funds

• government securities

• hedge funds, funds of hedge funds and exchange-traded funds

• structured notes and deposits

• cash, including bank and building society deposits.

In normal circumstances FPIL will not accept the following assets:

• shares in any company which is part of the group of companies of which Friends Provident International Limited is a member

• commodities

• real property

• futures and options

• precious metals

• UK National Savings and investments products

• US mutual funds, unless a fund is discretionary-managed

• Friends Provident International mirror funds.

25

Section 4: Appointment of an investment adviserPart A – Reserve

Reserve policy number (if obtained)

Name of investment adviser company (‘the adviser’)

Address of the adviser

DeclarationWe declare that we wish to appoint the adviser to act in respect of the underlying assets held within our Reserve policy, in accordance with the Investment restrictions specified on page 24. We request Friends Provident International to enter into any formal agreements required by the adviser to facilitate this appointment.

Authority grantedWe grant the adviser authority to act in the following capacity (please read the three options carefully before indicating the authority you have granted to your investment adviser):

Please tick one box only.

Option 1: Advisory basis only, signed consent required

We declare that the adviser will discuss any proposed alterations to the composition of our Reserve policy with us, and Friends Provident International will only act upon investment instructions that we, as policyholder(s), have signed. Friends Provident International will not action any instructions that have not been signed by us.

Option 2: Advisory basis only, without signed consent

We declare that the adviser will discuss any proposed alterations to the investment composition of the Reserve policy with us, and obtain our agreement before any changes are made. Friends Provident International will not action any instructions that have not been signed by us.

Option 3: Delegated investment management

We declare that we have delegated investment decisions to the adviser, who has complete discretionary authority, without consulting us first, to make all investment decisions to buy or sell assets, hold cash or other investments, within the boundaries of the investment restrictions detailed on page 25. We authorise Friends Provident International to act upon the investment instructions of the adviser as if the adviser was the policyholder.

We agree that Friends Provident International shall not be responsible for any loss or liability to our Reserve policy, as a result of the actions, or failure to take action, on the adviser’s part, or the part of any legal or natural person appointed by the adviser, which gives rise to any loss in value to the Reserve policy howsoever arising.We promise to repay to or reimburse Friends Provident International in respect of all losses, damages, liabilities, actions, proceedings, claims, costs and expenses (including legal expenses) arising from the activities of the adviser and any legal or natural person appointed by the adviser, (including, but not limited to, the cost of defending in any court of law such claim, demand or action against Friends Provident International and the cost of recovering the investments held by the adviser). We authorise Friends Provident International to act upon this authority until we revoke this authority in writing.

Part B – Reserve

Remuneration (please tick one box)

We have agreed with the adviser that a fee will not be paid.

We authorise Friends Provident International to make a quarterly withdrawal from the Reserve policy of

GBP EUR USD Other Amount a quarter

or % per annum, paid at the quarterly valuation point.

We understand that an amount equivalent to this withdrawal shall be payable by Friends Provident International to the adviser on our behalf.

Investment adviser For completion by the adviser.

This section refers to the provision of ongoing investment advice by an investment adviser. Only applicable to applications for Reserve.


Section 4: Appointment of investment adviser (continued)

Part C – Reserve

Investment restrictions

I agree to the investment restrictions listed on page 24.

Part D – Reserve

Fees and commissions

We are aware that certain investments the adviser makes from time to time may contain fees which exist partly to meet promotion and distribution expenses of the investment, including commission paid to our adviser. We understand that full details of any commissions paid in respect of certain investments held within the policy are available on request from our adviser.

We acknowledge that the above fees and commissions are in addition to Friends Provident International’s policy charges and any investment adviser fee taken under Part B.



Date

Member as co-trustee (if applicable)

Signature(s)


Date

Important noteIf you are licensed to provide financial advice in one of the following jurisdictions, please complete Part E below.

Australia, Canada, Gibraltar, Guernsey, IOM, Jersey, Mauritius, New Zealand, South Africa, Sweden, Taiwan, United Kingdom.

If you are not licensed in a country or jurisdiction listed above, please complete part F.

DeclarationOn behalf of the ‘Investment adviser’ named in Section 2, Part A, I have read and understood the Investment options specified on page 24 and agree to act in accordance with them. The capacity in which I will act as investment adviser will be: (please indicate below by ticking the appropriate box).

Please tick one box only.

Advisory basis only, (the trustees have selected Option 1 in Part A)

I confirm that I hold the appropriate authorisation to provide ongoing investment advice to the trustee(s). I understand that Friends Provident International can only act upon investment instructions that have been signed by the trustee(s).

Advisory basis only, (the trustees have selected Option 2 in Part A)

I confirm that I hold the appropriate authorisation to provide ongoing investment advice to the trustee(s). I understand that I must obtain the trustee(s) agreement to any investment advice given and that I may be asked to provide such agreement to Friends Provident International, if requested.

Delegated Investment Management, (the trustees have selected Option 3 in Part A)

I confirm that I hold the appropriate authorisation enabling me to provide investment instructions to Friends Provident International and that I have the agreement of the trustee(s) to issue investment instructions on their behalf.

27


Part E – Reserve

I confirm that I am licensed by a regulatory body located in one of the following jurisdictions:

Australia, Canada, Gibraltar, Guernsey, IOM, Jersey, Mauritius, New Zealand, South Africa, Sweden, Taiwan, United Kingdom.

and I am required by my regulatory body to comply with legislation in accordance with (or equivalent to) the EU Money Laundering Directives.

I am regulated by (name of regulatory body)

in (country) My regulatory licence number is

I confirm that I will comply with all legal and regulatory requirements of the country where I am licensed to provide financial advice. I confirm that I will notify you of any changes to my authorisation including any disciplinary action taken against me.

Signature of adviser

Date

Name of adviser

For and on behalf of (name of firm)

Address of firm

Telephone number

Fax number

Email address



Part F – Reserve

Identification requirements – notesThese notes apply only if Part E is completed.

The principal requirement is to look behind the corporate entity to identify those who have ultimate control over the business and company’s assets. Where the shareholder is a holding company, trust or nominee, then Friends Provident International is required to look behind this to the ultimate beneficial owner and verification of identity of the ultimate beneficial owner must be obtained, together with evidence demonstrating beneficial ownership.

Verification of the identity: this is deemed to comprise:

• Certified copy of the Certificate of Incorporation.

• A list of all Directors and certified ID & VOA for two, one of which must be an executive, (we will require full name, residential address, nationality and date of birth of each director).

• Evidence of the registered office address (if this is not the address on the application we require evidence that the address is being used and confirmation of why there is a difference).

• Confirmation that the company has not been, or is not in the process of being dissolved, struck off, wound up or terminated.

• A list of shareholders and certified ID and address verification for those holding 25% or more of the shares (we will require full name, residential address, nationality and date of birth for all shareholders).

I understand that its principal regulator requires Friends Provident International to complete an identification check on the investment adviser firm and I must provide identification requirements as in the above notes, if not previously provided, before this appointment of investment adviser form can be accepted.On behalf of the ‘investment adviser’ named in Section 4 Part A, I have read and understood the investment options in Section 4 Part A. I confirm that I will comply with all legal and regulatory requirements of the United Arab Emirates. I confirm that I will notify you of any changes to the brokerage including any disciplinary action taken against me or the company.

Signature of adviser

Date

Name of adviser

For and on behalf of (name of firm)

For and on behalf of (address of firm)

Telephone number

Fax number

Email address

Nationality

29

Discretionary fund manager For completion by the trustee(s).

Only applicable to applications for Reserve.

Section 5: Appointment of discretionary fund manager and custodian Part A – Reserve

Reserve policy number

Name of discretionary fund manager (‘the Manager’)

Address of the Manager

Name of custodian (‘the Custodian’)

Address of the Custodian

1 We declare that we wish for the underlying assets held within our Reserve policy to be placed in a discretionary account, which will be managed on a on a discretionary basis by the Manager. We further declare that we wish for the custodian, or any other legal or natural person appointed by the Custodian, to hold safe custody of these assets.

2 We acknowledge that these investments are held in the name of Friends Provident International and therefore it is necessary for Friends Provident International to enter into a formal agreement (‘the Agreement’) appointing the Manager and Custodian. We acknowledge that Friends Provident International may modify the Agreement at its absolute discretion, for example where the agreement allows for the provision of certain investments, but which can not be held within our Reserve policy.

3 We acknowledge that Friends Provident International is only prepared to enter into the agreement as a result of our request to appoint the Manager to manage and for the custodian to hold safe custody of the assets.

4 We agree that Friends Provident International shall not be responsible for any loss or liability to the Reserve policy, as a result of the actions, or failure to take action, on the Manager’s or Custodian’s part, or on the part of any legal or natural person appointed by the Manager or Custodian, which gives rise to any loss in value to the Reserve policy howsoever arising.

5 We promise to repay to or reimburse Friends Provident International in respect of all losses, damages, liabilities, actions, proceedings, claims, costs and expenses (including legal expenses) arising from the activities of the Manager or Custodian and any legal or natural person appointed by the manager or custodian, (including, but not limited to, the cost of defending in any court of law such claim, demand or action against Friends Provident International and the cost of recovering the investments). We agree that if Friends Provident International is obliged to pay any money to the Manager or Custodian, or any legal or natural person appointed by the Manager or Custodian, under the terms of the agreement, such money shall be deducted from our Reserve policy.

6 We acknowledge that Friends Provident International may terminate the appointment of the Manager or Custodian at any time as deemed necessary by giving written notice to us and the Manager or Custodian.

Part B – Reserve

We acknowledge that the manager will deduct a fee of

GBP EUR USD Other Amount a quarter

or % a year

of the value of the discretionary account at the quarterly valuation point, plus VAT. We acknowledge that the provision of discretionary fund management services by UK and non-UK discretionary fund managers is subject to value added tax (VAT) at the applicable UK rate. We agree that if Friends Provident International is obliged to apply VAT for discretionary fund management services, such money shall be deducted from our Friends Provident International policy.

We also acknowledge that other fees, including but not limited to buying and selling, safe custody and delivery charges will be deducted from the discretionary account, in accordance with the manager’s and custodian’s rates for such charges in force from time to time.


Section 5: Appointment of discretionary fund manager and custodian (continued)

Part C – Reserve

We wish to request that Friends Provident International appoints the manager to manage the assets contained in the discretionary account in accordance with the following investment and risk criteria:

1 Investment strategy (for example, cautious, balanced, aggressive)

2 Risk criteria (for example, low, medium, high)

3 Investment restrictions I agree to the investment restrictions listed on page 24.

4 Named investor status Retail Non-Retail

To assist with client classification, Friends Provident International’s definitions of a Retail and Non-Retail investor can be found below:

Retail Investor:A Retail investor is an investor who is not a Non-Retail (Qualified/Professional) Investor.

Non-Retail Investor (Qualified/Professional):1 A government, governmental institutions and authorities, or the companies fully owned by any of the aforementioned.2 International bodies and organizations.3 A person or entity licensed to engage in a commercial business, provided that one of the purposes of its business is managing

investments, including:a A person, body corporate, partnership, trust or other unincorporated association whose ordinary business or professional

activity includes acquiring, underwriting, managing, holding or disposing of investments, whether as principal or agent or giving advice about investments;

b Any director or partner of or consultant to a person referred to in paragraph (a);c A functionary to a professional investment vehicle or an associate of a functionary to a professional investment vehicle;d An employee, director or shareholder of or consultant to a person in (c) who is acquiring the investment as part of his

remuneration or an incentive arrangement or by way of co-investment;e A trustee of a family trust settled by or for the benefit of one or more persons referred to in paragraphs (c) or (d);f A trustee or operator of any employment benefit or executive incentive scheme or trust established for the benefit of persons

referred to in paragraphs (c) or (d) or their dependents; g A government, local authority, public authority or supra-national body in the Isle of Man or elsewhere.

4 A natural person who declares that their annual income is not less than £250,000, or their net equity, with the exception of their main home, exceeds £1,000,000.

In addition all managers will be issued with a revised Permitted Investments Schedule, which will illustrate which asset types can be held by clients depending on their status as a Retail or Non-Retail investor.



Date



Date

31

What you need to provide

Verification of identity, address and source of wealth accumulation

We have a legal obligation to verify the identity and residential address of each person who applies for one of our products. We also have a regulatory obligation to obtain details of how the trustee(s) has/have acquired the monies/assets that they will invest with us.

There are good reasons for doing this. Criminals and terrorists often try to launder money by using false or stolen identities in order to open accounts or place investments with financial institutions such as Friends Provident International. By providing the information and documents requested, you are not only helping us to comply with stringent money laundering legislation, but you are helping to protect your own identity.

Step 1

Verify the identity of each trusteeThe required documents to verify identity are:

• a passport; or

• a government-issued National identity card (carrying a photograph of the individual).

Where it is not possible to obtain either a passport or a government-issued national identity card, two other formal government-issued documents carrying appropriate personal details, which show verifiable reference numbers, may be accepted. Examples would include:

• a valid driving licence with photograph

• an annual tax assessment issued by the tax authorities

• a government-issued document containing a unique reference number which is specific to each trustee.

These documents must be certified (please refer to Step 3).

Step 2

Verify the address of each trusteeWe will also require an original or certified copy of a document, to verify each trustee’s residential address (please refer to Step 3). A list of the documents that are acceptable for this purpose is provided below.

The document must be issued in the name of the trustee and show the residential address that appears on the application form. In all cases the documents seen should be the most recent available, and no older than three months, unless the document used to verify address is only issued on an annual basis. Examples include:

• a utility bill, (water, gas, electricity, landline telephone connection) rates invoice, council tax notification; or

Please note, mobile telephone bills, cable TV bills and internet service provider’s bills are not acceptable as evidence of address.

• a current driving licence with photograph; or

• a tax assessment document; or

• an extract from the official Registrar of Electors

• a bank account statement

Please note, statements of credit cards and non-bank cards, such as store cards, are not acceptable.

• a state pension, benefit or other government-produced document showing benefit entitlements; or

• a letter from the trustee’s employer, confirming their residential address and the policyholder’s position within the company. Where the trustee has accompanied a partner or spouse on a work assignment or contract, and they are also an trustee, an employer may confirm the address of a non-employee where a relationship is detailed. If the trustee (or spouse) is the owner/part owner of the company a letter from the company will not be accepted;

• proof of ownership or rental of the residential address; or

• a mortgage statement.

These documents must be certified (please refer to Step 3).


Step 3

Authentication of documents by a suitable certifier (for each trustee)BackgroundIncorrect certification of documents is one of the main reasons for delays in processing applications. The UAE Insurance Authority and the Isle of Man Financial Services Authority are very specific about how documents are to be certified, and who can perform this function.

Certification of copy documentsThe certifier must state on the document:

‘I certify that this is a complete and accurate copy of the original documentation that I have seen.’

Signed (the signature of the certifier)

Name (the printed name of the certifier)

Position or capacity (the position or capacity of the certifier)

Date (the date of certification)

Improper certification could lead to delays.

If the document is more than one page the certifier can either:

• certify each page individually or,

• certify the top page and add a statement detailing the number of pages of the original documentation seen.

Who can certify a copy of an original document?• The adviser who has been appointed by us as a suitable certifier for financial advisory firm you are dealing with.

• A notary public, licensed lawyer or solicitor.

A notary public is a public officer appointed under authority of state law with power to administer oaths, certify affidavits, take acknowledgements and take depositions or testimony.

• An authorised representative of an embassy or consulate of the country that issued the identification documents.

• An employee of Friends Provident International Limited.

Translation of documents not written in EnglishWhere a document submitted for address verification is not written in English, we require the certifier to explain on the document:

• What the document is

• Indicate where the trustee’s name and address are printed

• The certifier should also write a statement onto the document to the effect that:

‘I certify that the address stated on this document is a true translation of the English address written on the application form’

Signed (the signature of the certifier)

Name (the printed name of the certifier)

Position or capacity (the position or capacity of the certifier)

Date (the date the certifier has certified the copy document)

33

Step 4

BackgroundThe UAE Insurance Authority and the Isle of Man Financial Services Authority, through their Anti-Money Laundering Guidance, require all companies to obtain information and documentary evidence on the source of wealth of new investors. This source of wealth information is an integral part of the overall ‘Know Your Client’ (KYC) requirements that we must perform. It is also a legal, as well as a regulatory requirement, to perform a risk-based assessment of the applicant and conduct enhanced due diligence where higher risk circumstances are identified. This means that in certain circumstances independent evidence will be required to support the explanation of the client’s source of wealth. Incorrect certification of documents is one of the main reasons for delays in processing applications.

Information to be providedOn pages 15 to 17 of this application form, you should clearly explain how you have acquired the wealth that you will use to make payments.

Supporting documentation to evidence source of wealthWe use both the premium size and your residential location to identify when applications require documentary evidence. Evidence will be required where the premium is on or above the limits.

Premium levels and country risk ratings are subject to alteration and for that reason you will need to refer to the premium limits table published on our website.

You will need to combine the premium levels indicated in the premium limits table with the risk rating of your country of residence (or country where wealth is generated), to determine whether evidential support should be submitted with this application. We need documentary evidence each time a premium moves the total cumulative premium on, or higher, than the premium limits allocated to the particular country risk. Your financial adviser, who has recommended this product to you, will be able to help and advise you with this.

Important note to the introducing intermediary: ALL COPIES of original documentation must be properly certified by you, the introducing intermediary, in the same manner as you would certify client identity documentation and residential address proof.

Trust applicationsWhere the payment is made by the trustees, the same source of wealth information as above should be provided for the settlor and settled monies.

Product informationThe information given in this document is based on Friends Provident International’s understanding of current laws and Isle of Man taxation practice which may change in the future. No liability can be accepted for any personal tax consequences of this scheme or for the effect of future tax changes or legislative changes. We do not condone tax evasion and our products and services may not be used for evading your tax liabilities.

A copy of the policy document and provisions may be obtained from us on request.

Insurance policies may not be suitable for everyone. Investment involves risk and each class of investment will involve its own individual level of risk. We recommend that you read the product brochure, product guide and policy conditions carefully and discuss fully both the suitability of the product and the specific risks associated with individual investments with your financial adviser before making any investment decisions.

Reserve and Summit are intended for medium to long-term investment and not therefore designed for early surrender. If you do surrender your policy early, a surrender charge may be applied. The earlier you terminate your policy, the more you may lose.

Mirror fundsAll mirror fund performance is quoted net of annual charges. However, mirror fund performance should not be viewed as an indication of future performance – the value of your investment cannot be guaranteed and you may get back less than you paid in. Mirror fund prices may go up and down depending upon the underlying investment performance or, where investments held within a mirror fund are not denominated in the currency of that mirror fund, simply because of movements in currency exchange rates.

Policyholder protectionTo ensure the protection of policyholders’ interests there are a number of measures in place that apply to business written by Isle of Man authorised insurers:

• Ring-fencing of assets — the Insurance Act 2008 requires insurers to keep payments received in a special ‘long-term business fund’, which (subject to certain very limited exceptions) can only be used to meet the claims and long-term liabilities of policyholders. It also requires the insurer to hold funds in excess of its long-term liabilities, and submit independently audited annual solvency reports to the regulator.

• A policyholder compensation fund — in the event that the above measures fail, and we are unable to meet our liabilities, all policyholders will benefit from the protection of the Life Assurance (Compensation of Policyholders) Regulations 1991 of the Isle of Man, wherever their place of residence. The regulations provide that in the unlikely event that we become insolvent, a levy would be made against all other Isle of Man resident life assurance companies so that up to 90% of our liabilities to policyholders would be met (without any upper monetary limit).

Further information

The information given in this document is based on our understanding of current law and taxation practice as at March 2019, which may change in the future. No liability can be accepted for any personal tax consequences of this policy or for the effect of future tax or legislative changes.

Investment involves risk. Past performance should not be viewed as a reliable guide of future performance. Fund prices may go up and down depending upon underlying investment performance, and the value of your investment cannot be guaranteed. Investments held within a fund may not be denominated in the currency of that fund and the value of those assets can go up and down simply because of movements in currency exchange rates. All fund performance is quoted net of annual charges.

All policyholders are protected by the Life Assurance (Compensation of Policyholders) Regulation 1991 of the Isle of Man, wherever their place of residence.

Investors should be aware that specific investor protection and compensation schemes that may exist in relation to collective investments and deposit accounts are unlikely to apply in the event of failure of such an investment held within insurance policies.

Complaints we cannot settle can be referred to the UAE Insurance Authority. You can contact the UAE Insurance Authority at Aldar HQ, Al Raha beach, Abu Dhabi.

Some telephone communications with Friends Provident International are recorded and monitored.

Each policy is governed by and shall be construed in accordance with the law of the United Arab Emirates. If you effect a policy whilst resident in the United Arab Emirates, all disputes regarding your investment will be subject to the jurisdiction of the courts of the United Arab Emirates.

XUA/TA-PENSION 04.19 (12904)

Friends Provident International Limited: Registered and Head Office: Royal Court, Castletown, Isle of Man, British Isles, IM9 1RA. Telephone: +44 (0)1624 821212 | Fax: +44 (0)1624 824405 | Website: www.fpinternational.com. Isle of Man incorporated company number 11494C. Authorised and regulated by the Isle of Man Financial Services Authority. Provider of life assurance and investment products. Authorised by the Prudential Regulation Authority. Subject to regulation by the Financial Conduct Authority and limited regulation by the Prudential Regulation Authority. Details about the extent of our regulation by the Prudential Regulation Authority are available from us on request. Dubai branch: PO Box 215113, Emaar Square, Building 6, Floor 5, Dubai, United Arab Emirates. Telephone: +9714 436 2800 | Fax: +9714 438 0144 | Website: www.fpinternational.ae. Registered in the United Arab Emirates with the UAE Insurance Authority as an insurance company. Registration date, 18 April 2007 (Registration No. 76). Registered with the Ministry of Economy as a foreign company to conduct life assurance and funds accumulation operations (Registration No. 2013). Friends Provident International is a registered trademark and trading name of Friends Provident International Limited.

Copyright © 2019 Friends Provident International Limited. All rights reserved.

Documents

Pension trustee application form (UAE)